Awareness
by Kate Christie
Summary: Kate wakes up after open heart surgery.


Awareness

**AN: Castle = Not Mine. Sad, really. I could think of so many fun things to do with him… **

She hadn't moved in hours. Really. Not an eyelid flutter. Not a finger twitch. Not a single muscle had moved. The ventilator was breathing for her, so said Susan, the petite Cardiovascular ICU nurse with the Texas accent. She had been with them since Kate entered this fishbowl of beeping machines and flashing monitors that they called a room, after her 6 hours of emergency surgery.

Castle knew she hadn't moved, because he had talked Susan into allowing him to sit with her through the night, despite the fact that the blatantly-posted and PA-system-declared visiting hours for the ICU had ended about 15 minutes after he was allowed to enter her room.

He might have his reasons for hating Josh Davidson, but the fact that a bleeding, unconscious Kate Beckett entered his hospital with a bullet lodged against her 4th vertebra after tearing the wall of her aorta and then subsequently left his OR sans bullet and with her body's largest artery repaired, did warrant a modicum of respect for doctor motorcycle boy.

Josh, or Dr. Davidson, as Susan insisted upon calling him all night, had been in twice since the surgery to check on her vital signs and her drains. He had glanced at Castle and raised an eyebrow at Susan, simultaneously acknowledging the nurse's complete authority within the domain of this ICU room and questioning why a non-family visitor was sitting at _his_ girlfriend's bedside, holding her hand, at midnight and again at 3AM.

God, there were so many tubes draining out of her, Castle didn't think there could possibly be anything left inside. Susan had explained: there was a tube draining the space around her heart, to keep any blood or swelling from building up that might keep her heart from being able to pump. There were IVs in her arms for fluids and medications. There were pacer wires inserted against the outside surface of her heart, since they had been operating nearby, just in case the tissue got too inflamed and stopped it from beating properly. Thankfully, despite a few unruly beeps, the heart monitor had remained steady.

There was the breathing tube attached to the ventilator, which had been in place since before surgery and would be there until they lightened her sedation so she could wake up and breathe on her own. Jack, the sandy-haired respiratory therapist who enjoyed flirting with Susan, had been in checking on her oxygen saturation and drawing blood to look at how she was doing with the ventilator settings.

There was the O.G. tube, which went down to her stomach to give some of her medications. A huge IV went into the vein on one side of her neck. Castle had been standing outside the ER booth peering over heads and around curtains while that was placed. And there was an arterial line in her wrist, keeping close track of her blood pressure. He wasn't allowed to hold that hand, he learned almost immediately, since it made the monitor screech in a very shrill and annoying way.

He was pretty sure he had missed a few tubes.

His mind was craving details. Anything he heard, he imprinted, thinking it might be somehow useful or important. Hoping that sometime _he_ might be somehow useful or important again.

In his quest to sit with her, as Susan commanded, "quietly, as long as nothing is beeping that makes us have to do something," Castle had sat holding Kate's right hand, sitting on the edge of a semi-padded pink chair that complemented the Pepto Bismol color of the walls. He didn't dare touch anything other than her hand for fear of setting off a machine. Susan mostly stood or sat just outside the sliding glass door, at a computer workstation that overlooked Kate's bed but also gave her real time vital signs and alerted her of any new orders from "Dr. Davidson." She kept the sliding door cracked open, but she seemed willing to ignore the fact that Castle had been whispering non-stop to Kate, except when Josh was in the room.

After a litany of "You are going to be OK" and "I love you so much," he had resigned himself to doing what he did best—telling a story. He told her about what was going on in the ICU, about Susan and her purple Snoopy scrubs, about the other people he could see through the glass doors to her room, who looked, by the way, much worse than she did. He told her everything he knew from cell phone updates about Ryan and Esposito's search for the shooter. He told her that Alexis and his mother were waiting in the waiting room with her dad so he wouldn't be alone.

Jim had come in right after surgery with Castle and laid his head on the bed next to her shoulder, tears falling on her blanket. He told her he loved her and then told Rick to let him know when she woke up. They had shared a look that said Jim didn't have the strength to hold a vigil at her bedside. Rick had told him he would be out as soon as she moved.

And she hadn't moved.

About 5AM, Susan had come in and changed something on one of the IV pumps. Since then, Kate's heart rate had slowly increased. Her breathing rate had increased, too, but nothing else. He was about to give in to the utter exhaustion that he had been putting off with adrenaline and drop his head to the mattress to take a nap when Susan tapped on the doorframe and entered.

"Mr. Castle, I know I've let you stay all night, but Dr. Davidson and Jack are going to be coming in at 6 to see if we can let her wake up enough to remove the breathing tube." She looked genuinely sorry. "You just can't be here for that; you would be in the way of all the people that need to help her. I promise I will come get you as soon as we finish."

At that exact moment, he felt a twitch from the limp hand he had been holding all night. A series of screeching beeps came from the blood pressure and heart monitors. There was a new one, too—her ventilator was complaining loudly about something in a totally different key of annoyance.

"See there. Her sedation has already worn off. Mr. Castle, I'm going to need for you to go now." Susan stepped outside and called to the center desk. "Please grab Jack, or if he's next door, please page him. Bed 7 is waking up. Please page the on call, the ICU fellow, and Dr. Davidson as soon as you get Jack."

Susan had a remarkable aura of calm about her through all the insane beeping. She returned to Kate's bedside, silenced all the monitors with 3 succinct button pushes, and started speaking in a soothing tone to her patient.

"Kate, it's OK. Can you open your eyes, sweetheart? I know you are uncomfortable. You have a machine helping you breathe. You had surgery, and you're going to be fine. We'll get the breathing tube out in just a second. I need you to relax and let the machine keep breathing for you for just another minute."

At the mention of her name, Kate had gripped his hand again. This time was no twitch—she had a vice grip on his fingers.

"Mr. Castle, I am a very nice person, and I have let you stay here even though I should have kicked you out hours ago. My niceness is going to end when Jack and the docs get in here and they blame me for letting a visitor be here for an extubation."

At his blank look she explained, "for removing her breathing tube."

"Susan, I'm not arguing, but she just grabbed my hand. Really HARD. I don't think"

Jack slid the door open and interrupted "So we're ready to take this tube out, I see?"

Kate still had not opened her eyes. The RT went to a rolling table in the corner of the room that had been sitting prepped since she wheeled in from surgery, removing the top drape and rolling it to her bedside.

Just then Kate did open her eyes, wide. Her gaze was unfocused but her eyes shifted from Jack to Susan to Castle, paused there and then kept shifting. She tried to sit up. He was thrilled just to have her looking back at him. God, the machines seemed to be getting louder. He hadn't thought they could be more obnoxious, but obviously he was wrong.

"Kate, hey, sweetheart. It's OK," Castle was hoping his voice exuded a sense of calm he did not feel.

Susan and Jack immediately each reached for one shoulder and one knee to prevent her from hurting herself.

"Ms. Beckett, you have to lie back," Jack spoke with a calm that could only come from dealing with these situations thousands of times before.

"Kate, I know you are uncomfortable. We are going to take the tube out right now, but we need you to be calm and lay down, OK?" Susan was a bit sweeter, like a mom telling her little girl that they needed her to be still while they took off the bandaid and then it would all be over.

"Susie, we don't take this out right now and she's takin' it out herself…" Obviously Jack and Susan had done this a few times.

"Davidson's not here yet." She pinned Jack with a glare and a raised eyebrow that had an amazing resemblance to Kate's special Castle death glare. "He wrote his personal pager on my sign-out sheet to call him to be here for anything…"

Meanwhile, Castle had inched closer to Kate's ear. She hadn't relinquished her death grip on his hand, so he didn't see any other feasible option. And more importantly, she had fixed her extremely frightened eyes directly on his.

"Kate. Listen to me. You have to calm down. Lie back. I know you don't like having your hands restrained—they had to do it while you were asleep so you wouldn't pull out any tubes. Try to calm down and lie back. Susan and Jack are just trying to help you, but you have to let them."

She blinked slowly at Castle and something seemed to click. She stopped trying to sit up and fight the wrist restraints. She was still fighting the breathing tube, though.

Just then an extremely young-looking brunette in pale green scrubs walked in, pulling a stethoscope from around her neck.

"Ah, Dr. Clark. Impeccable timing, as always," Jack sing-songed as he released Beckett's shoulder and turned to the ventilator.

"Self-extubation in progress, Jack? Somehow we always meet when your patients are trying to do your work for you…." As she stepped up to the bed she raised an eyebrow at Castle still holding her patient's hand, but then focused on the beeping monitors.

Susan, placating, chimed in while still keeping one hand on Beckett's left shoulder. "Davidson was paged right before you, but you see the urgency of the situation…"

"I'm good to go if y'all are." It had taken Melissa Clark about 7 seconds to assess that this patient was certainly awake enough to breathe on her own. Davidson could get mad later, but this woman was going to cough out her ET tube and rip a vocal cord any second if they didn't remove it for her. She pinned Castle with a glare rivaling Beckett's worst.

"Sir, can you please wait outside."

"She won't let go of Mr. Castle's hand, apparently," Susan said, rolling her eyes toward Castle in answer to Clark's request.

"This is not a pleasant process, Mr. Castle. Wait, really? Like Richard Castle the novelist, Mr. Castle?"

For all of Rick's usual fame, Dr. Clark looked suddenly much more annoyed than she had been a moment earlier.

"That's me," but Castle only looked away from Kate's wide and frightened eyes for a split second to address her. She blinked slowly at him and sighed, sounding remarkably like Kate.

"OK, Mr. Castle, since you're not leaving, keep an open mind. This never looks fun. I expect full credit in on the jacket when this shows up in your next Nikki Heat novel. Jack, you ready?"

Jack had moved in close to Kate and reached for the tape around her lips.

"OK, Ms. Beckett, worst part is the darn tape. I promise I'll be quick," and without giving her time to think about it, he had the tape off and the balloon of the tube deflated.  
>Castle heard a whooshing noise.<p>

"We've got a good air leak."

"Get this show on the road."

Jack used one hand to remove the tubes and the other to clean Kate's face, followed immediately by an oxygen mask. Susan had the tubes out of sight and the beeping machine turned off in seconds.

If Rick thought Kate had him in a death grip before, this was more like Meredith in labor with Alexis before the drugs kicked in… God, his pinkie might actually be dislocated…

"Cough for me, Ms. Beckett. A couple of good strong coughs," Jack spoke in her ear.

Kate had kept her eyes on Rick the whole time, and now she heaved a huge breath and coughed, clearing whatever had settled while the tube was in place.

"Oww!" she hoarsely whispered.

"Oh, Kate, don't talk, you need to let your vocal cords rest for a while. I know it hurts to cough; that's from the surgery. We'll get you some medicine for the pain right now," Susan turned to one of the IV pumps and dialed up the rate of one of the drips.

"Take some deep breaths Ms. Beckett. Slow, deep breaths." Jack had a voice like a midnight DJ on the smooth jazz station. Kate settled back into her pillow breathing slow, measured breaths. The room had suddenly become much quieter.

Susan removed her restraints. "Call me if you need anything, Susan. I'm going back next door," Dr. Clark looked suspiciously like she wanted to be anywhere but here.

"Sats are great. Thanks Jack."

"Always a pleasure. I'll be back in half an hour for a blood gas," he ducked out almost as quickly as Clark.

A moment later, Rick knew why.

"What's going on Susan?" Josh, while not exactly yelling, was easy to hear through the glass sliding door. "Why was she extubated before I arrived? I gave you specific instructions to wait for me. And where is respiratory, anyway?" His voice grew louder as he slid open the door.

"What are you doing here?" his distaste was undisguised as he stalked to Kate's side.

"Dr. Davidson, she was quite awake, and I did page, but we were afraid she was going to panic and cough out the tube. Jack and Dr. Clark were both here—they just left when they saw her sats were stable. And he," she tipped her head toward Castle, "wouldn't leave." Susan gave him the _I-warned-you-this-would-happen_ look.

Kate was still squeezing Rick's hand for dear life. She was watching Josh, who had paid attention to her nurse, her chart, her monitors, and her bedside companion all without a glance at her. His eyes travelled from her hand clasped in Castle's up to her face.

"Kate, sweetheart," God, was it him, or did that word just sound icky coming out of Josh's mouth? "I wanted to be here when you woke up. I'm so sorry. Are you hurting?"

"When I cough," she croaked.

"Oh, don't talk; you need to rest your voice."

_Then don't ask her direct questions, moron._ Castle hoped that had been his inside voice. Apparently so, since he didn't get clobbered.

"I had to sew up part of your aorta, the big artery that comes out from your heart. The bullet also hit the edge of your lung, so we repaired that as well. You lost a lot of blood, but we gave you some back and stopped all the bleeding. You're going to be sore where we had to open your chest, and you'll need to take it easy and do a lot of rehab. But you're going to be fine." He had his hand on her shoulder in a very non-doctor-patient sort of way.

Kate nodded at him and mouthed, "Thank you."

"Josh, yes, thank you for saving her life."

"Mr. Castle, can I speak to you in the hallway for a moment, please," Josh asked in a barely-restrained growl.

"Uh, sure. Kate, I'll be right back, I promise." She released his hand and he missed the connection immediately.

**A/N: This was just a snippet. No way Marlowe would write about something as mundane and harrowing as a cardiac surgery patient waking up after surgery, but a girl can dream! Maybe this will fit somewhere in the first few minutes of the premiere.**


End file.
